Neighborhood resources associated with frailty trajectories over time among community-dwelling older adults in China

Background and objectivesRecent research has identified neighborhoods as an important contributor to later-life frailty. However, little is known about how neighborhood resources are associated with frailty trajectories over time, especially in developing countries. This study examines the impact of neighborhood physical and social resources on the trajectories of frailty over time among older people in China.Research design and methodsUsing the four waves of the China Health and Retirement Longitudinal Study (2011–2018), 5673 respondents aged 60 and above at baseline were included for analyses. Multilevel growth modeling was fitted to estimate the effects of neighborhood resources on frailty trajectories over a 7-year period, controlling for individual-level characteristics.ResultsOlder Chinese people who lived in neighborhoods with better basic infrastructures and a greater number of voluntary organizations were less frail at baseline. Accessible exercise facilities were associated with a lower initial level of frailty only among rural older adults, while higher community-level socioeconomic status (SES) was associated with a lower initial level of frailty only among urban older adults. Over the 7-year follow-up period, better basic infrastructures and accessible exercise facilities were associated with a slower increase rate of frailty scores among rural residents.Discussion and implicationsNeighborhood resources are important contributors to the level of frailty among older Chinese people. Our findings of significant urban-rural differences have important implications for designing and implementing infrastructure development and community building programs in rural and urban China.     

江西省2017年度临床核医学应用频度调查与分析

目的 掌握江西省临床核医学应用频度和受检者的分布特点，估算2017年全省临床核医学应用频度。方法 对全省范围内开展临床核医学工作的各级医疗机构进行普查，以发放调查问卷的形式对样本医院进行应用频度调查与分析。结果 除正电子发射断层扫描（PET）检查男性多于女性外，其余临床核医学诊疗项目均为女性多于男性；全省临床核医学诊疗应用频度为0.67人次/千人口，其中诊断频度为0.58人次/千人口，治疗频度为0.09次/千人口。结论 与"九五"期间相比，江西省临床核医学应用频度迅猛发展，有必要进一步规范核医学诊疗工作，增强核医学工作人员的放射防护意识，促进核医学健康有序地发展。     

中药特殊煎法的探讨与思考(三):包煎

"包煎"是中药汤剂特殊煎法的一大特色,而一些人对需包煎的中药、包煎的原因以及如何包煎缺乏基本的认识或存在一定的误解,从而出现因中药煎煮不当导致的临床疗效不佳或副作用等一系列问题。结合古今文献,尝试剖析中药包煎的原因及注意事项,并对如何包煎提出探索性的思考,为中药包煎提供科学依据以促进临床合理用药。     

高危原发前列腺胃肠道外间质瘤诊疗体会及文献复习

目的探讨前列腺原发胃肠道外间质瘤诊治要点。 方法回顾性分析我院2017年9月诊治的1例高危原发性前列腺胃肠道外间质瘤临床病理特征资料、随访情况，总结现有文献讨论总结本病诊治心得。 结果65岁男性，因"前列腺电切术后2年，反复血尿3个月余"入院。术前MRI考虑为来源不清的盆腔巨大实性占位（115 mm×105 mm×85 mm），经直肠穿刺诊断为梭形细胞来源的肿瘤。行盆腔肿瘤切除+膀胱前列腺腺切除+盆腔淋巴结清扫术+Bricker术。术后病理提示为前列腺原发胃肠道外间质瘤[CD117（+）；Dog1（+）；CD34（+）；PSA（+）；AR（+）；P504s（+）；Ki-67（2%）]。术后肿瘤组织全外显子测序提示为C-Kit基因（Exon 11 p.Q556-V560del）存在明显临床意义突变，筛选靶向药物甲磺酸伊马替尼+比卡鲁胺（PSA平稳后停用）口服，术后随访18个月无肿瘤复发及不良并发症。 结论前列腺原发胃肠道外间质瘤罕见，需与前列腺其他良恶性肿瘤相鉴别诊断。全外显子测序了解其发病高危基因，同时筛选药物辅助治疗可使患者生存获益。     

数据之美——聚焦全球器官捐献发展趋势

器官移植术是20世纪出现的针对器官功能衰竭的最有效治疗方法，每年拯救全球超过12万例患者。但供器官短缺的现状，与器官移植技术和辅助药物的发展不匹配，制约了器官移植事业的发展。我国自2015年起已成为全球器官捐献和移植大国之一，2017年公民逝世后器官捐献数量超过5 000例，占全球捐献总量的15%以上。黄洁夫教授总结的器官捐献与移植"中国模式"得到了世界卫生组织、国际移植界的高度重视和充分肯定。本文通过整理全球及各国的器官捐献与移植数据，剖析全球现状与发展趋势，进一步探索我国公民器官捐献的影响因素并提出针对性的应对策略，以期实现我国器官捐献和移植的"自给自足"。     

嗜肺军团菌致病性与效应蛋白的研究进展

嗜肺军团菌是一种可以引起军团菌肺炎和庞蒂亚克热的兼性胞内病原菌，主要侵染阿米巴原虫和人类巨噬细胞。该菌在宿主胞内能依靠Dot/Icm IVB型分泌系统产生的效应蛋白成功逃避溶酶体的降解。本文主要对嗜肺军团菌的致病物质、胞内存活与增殖机制及其效应蛋白的生物学功能进行综述，详细介绍嗜肺军团菌的毒力因子与致病机制，为军团病防治的研究提供新思路，也为其他胞内病原菌所致感染性疾病的研究提供重要的借鉴意义。     

Homocysteine might increase the risk of recurrence in patients presenting with primary cerebral infarction

Purpose: Although hyperhomocysteinemia (Hhcy) is a risk factor for cerebral infarction, its effect on recurrent cerebral infarction is less-defined. We aimed to investigate the association of Hhcy and increased risk of recurrent cerebral infarct.

Materials and methods: From 2011 to 2013, we recruited 231 primary cerebral infarct patients that were divided to a Hhcy group (n?=?105) and a control group (n?=?126) according to plasma homocysteinemia (Hcy) levels exceeding 15?μmol/L. In this prospective study, risk factors such as gender, age, blood lipid and glucose levels, history of diabetes, high blood pressure, smoking habits and plasma Hhcy levels were determined. A three-year follow-up compared differences in cerebral infarction recurrence rates. Statistical analyses identified whether plasma Hhcy levels were an independent risk factor for recurrent cerebral infarction.

Results: Triglyceride and low-density lipoprotein (LDL) levels in the Hhcy group were significantly higher than controls, and cerebral infarct recurrence rates in the Hhcy group exceeded control subject rates through the three-year follow-up (p?=?.021, p?=?.036 and p?=?.025). Cox proportional hazards modeling showed that elevated Hhcy levels (hazard ratio [HR]?=?3.062, p?<?.001), increased age (HR?=?1.069, p?<?.01), circulating triglyceride levels (HR?=?1.686, p?=?.048), and relative National Institutes of Health Stroke (NIHSS) score (HR?=?1.068, p?=?.016) were risk factors for recurrent cerebral infarction.

Conclusions: Level of Hhcy was a risk factor for recurrent cerebral infarction. Further, particular demographic and clinical outcomes including age, relative NIHSS scores, and circulating triglyceride levels were markedly associated with the occurrence of cerebral infarction.     

理气中药组方对糖尿病大鼠胃排空延迟的作用

目的:观察理气中药经验组方对糖尿病大鼠胃排空延迟的干预作用。方法:雌雄各半成年SD大鼠110只,随机分为正常组(A组)、糖尿病中药组(B组)、糖尿病胃复安组(C组)、糖尿病组(D组)。A组、D组1次/d按10 mL/只予0.9%生理盐水灌胃,B组1次/d按8 mL/只予中药煎剂灌胃,C组1次/d按0.5 mg/只予胃复安片灌胃。喂养12周后,行13C胃排空实验及甲基橙水溶液胃排空实验,观察各组大鼠胃排空情况。结果:糖尿病大鼠胃排空较正常大鼠明显延迟(P0.01),糖尿病大鼠胃排空延迟模型制作成功。糖尿病中药组和糖尿病胃复安组大鼠胃排空较糖尿病组快(P0.01);糖尿病中药组大鼠胃排空较糖尿病胃复安组大鼠快(P0.05)。结论:常规喂养12周后糖尿病大鼠出现胃排空延迟。理气中药陈皮、枳实、木香、香附组方煎剂和胃复安均能促进糖尿病大鼠胃排空,理气中药组方煎剂的效果优于胃复安。